Challenges in Management of a Post-Traumatic Stiff Elbow - When to Perform Open Arthrolysis: A Case Report

Elbow stiffness can be a debilitating condition that significantly impacts a individual's ability to perform activities of daily living (ADL). Neglected distal humerus fractures when left untreated result in malunion causing the elbow joint to undergo arthrofibrosis with capsular contracture with interspersed osteophytes and formation of loose bodies. The elbow joint is particularly susceptible to stiffness due to its highly congruent bony anatomy, relatively confined joint space tightly stabilizing collateral ligament complex, and the close relationship of the surrounding muscles acting as secondary stabilizers.

A 31-year-old man presented to the OPD 5 months after injury following 3 cycles of native splinting for distal humerus fracture. He had severe painful restriction of movements, with diffuse tenderness and deformity over the elbow joint affecting his ADL. He underwent a left elbow manipulation under anaesthesia after capsular release.

Late presentation of distal humerus intra-articular comminuted fracture which has undergone mal-union can present with gross elbow stiffness commonly. Moreover, if the fracture was treated with native splinting or prolonged immobilisation it is prone for stiffness and other complications. Open approach confers additional advantage of addressing the bony hindrance in addition to soft-tissue release.

The clinical decision of choosing open approach versus arthroscopic approach is determined by the severity of the stiffness. In our case, since the patient has severe stiffness with only 30° arc of motion, we decided to go ahead with an open arthrolysis and the patient had good functional improvement.